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Journal Article


Health Care When Workers Need It Most: Before and After Entry into the Social Security Disability Insurance Program

The Issue

When workers become seriously injured or ill, health insurance and access to care take on added importance. Appropriate and timely care can help preempt serious health consequences and involuntary withdrawal from the workforce. Although those who must stop working because of a disability receive Social Security Disability Insurance (SSDI), they do not become eligible for Medicare until after a 24-month waiting period. This Commonwealth Fund–supported study looks at the insurance status, health care access, and other characteristics of SSDI beneficiaries during the three years before and three years after entry into the program.

What the Study Found

Prior to SSDI entitlement, beneficiaries had employment rates similar to those of all people between the ages of 18 and 64, but those rates dropped markedly during the year before entitlement and continued to decline in the years after entitlement. In addition, beneficiaries reported an increase in health deterioration in the years leading up to and following SSDI entry. Prior to SSDI entry, a large share (22%) of beneficiaries were uninsured, compared with 16 percent of all working-age individuals. These rates remained high until the third year after entry, when they became eligible for Medicare. Beneficiaries experienced health care access problems at rates at least as twice as high as the general population. The share of beneficiaries reporting that they needed but were unable to get medical care increased in the years before SSDI entry, and declined after entry.


Affordable and reliable health insurance coverage that is universally available, regardless of employment or disability status, would address problems facing SSDI beneficiaries. Earlier provision of insurance and greater health care access could help delay the onset of disability, withdrawal from the labor force, and application to SSDI.

Publication Details



G. A. Livermore, D. C. Stapleton, and H. Claypool, "Health Care When Workers Need It Most: Before and After Entry into the Social Security Disability Insurance Program," Inquiry, Summer 2010 47(2):135–49.